Interventional Radiology – Flashcards

Definition
-Are minimally invasive radiologic procedures that use angiographic techniques to:

-Diagnose disease (while providing diagnostic information through angiographic procedures

Radiologic examination of vascular structures within the body after introduction of iodinated contrast medium or gas

—Angiographic procedures are categorized as either visceral or peripheral

Arteriography – Image of arteries

Venography – imaging of the veins

Angiocardiography – imaging of the heart and associated structures

Lymphography – imaging of the lymphatic vessels/nodes

Primarily used to identify the anatomy or pathologic process of blood vessels.

-Arteriograms – are performed to assess the severity of a stenosis or occlusion in a vessel caused by atherosclerosis.

-Cerebral angiography – is performed to detect and verify the existence and exact position of an intracranial vascular lesion such as an aneurysm

-Most angiographic exams are performed to investigate anatomic variances but others are used to evaluate the motion of the part.

-Vascular exams evaluate the suspected tumors by opacifying the organ of concern

-To evaluate traumatic injury

-Treating vascular disease
(Stroke, intracranial hemorrhage)
-Reducing blood flow to a highly vascular structure and tumor before surgery
-Stop active bleeding at a specific site
-Delivering a chemotherapeutic agent
-Providing alternatives for patients who are not candidates for surgery

Vessel Access
Guidewires
Catheters
Contrast media
Patient Preparation and Monitoring
Contraindications and Risks

-Needed to visualize the vessels of interest
-A commonly used method for catheterization is the Seldinger technique

-Femoral, brachial, & axillary

-In angiography, the common femoral artery is the preferred site for arterial access

-Used to allow the safe introduction of the catheter into the vessel.

-Coated with a hydrophilic material so catheter slides over the wire more easily.

-Designed to reduce friction; include Teflon, heparin coatings, and hydrophilic polymers called glide wires

Catheter diameter is categorized in French (Fr) sizes; 3 Fr equals 1mm in diameter

Usually a water-soluble, nonionic iodinated, and radiopaque compound that is injected through the catheter for visualization of vessels

contrast media allergy,
impaired renal function,
blood-clotting disorders or taking anticoagulant medication, and unstable cardiopulmonary / neurologic status

Bleeding at the puncture site- most common risk

a blood clot may form in a vessel and disrupt the flow to distal parts

A piece of plaque

catheter may tear the intima of a vessel

caused by contamination of the sterile field

may be mild, moderate, or severe

penetrating injury may occur

1. Cerebral angiography
2. Thoracic Angiography
3. Angiocardiography
4. Abdominal Angiography
5. Peripheral Angiography
6. Lymphography

Primary purpose is to provide a vascular “road map” that enables the localization and diagnosis of pathology or other anomalies of the brain and neck region.

-Common Carotid Arteriography
Most frequently performed angiogram study to visualize the common carotid arteries

-Internal Carotid Arteriography
Allows visualization of the internal carotid arteries and the bifurcation into the anterior and middle cerebral arteries

-Demonstrates the contour and integrity of the thoracic vasculature
a) It’s essentially an angiographic study of the ascending aorta, arch, descending aorta, and major braches

Oblique visualization of the aortic arch, usually performed with the patient in a 45° LAO position

Demonstrates the arterial phase of a pulmonary angiogram, usually done to investigate for pulmonary embolus

radiologic imaging of the heart and associated structures

Typically performed with angiocardiography to visualize the coronary arteries

-Performed to identify the anatomic and physiologic condition of the heart
– Data provides information on patients cardiovascular disorders

-Involves the introduction of specialized catheters into the heart and surrounding vasculature for the purpose of diagnostic evaluation and therapy intervention

Demonstrates the contour and integrity of abdominal vasculature

Radiologic examination of the peripheral vasculature after the injection of contrast media

Injection by a catheter into an artery of an extremity

-Injection into a vein of the extremity

-Venograms are now rarely performed due to the increased use of color duplex ultrasound to better demonstrate pathology

performed to visualize the lymph vessels and nodes.

-Lower limb procedures are the most common but upper limb procedures are also done

-Embolizations:
Uses an angiographic approach to create an embolus in a vessel, thus restricting blood flow

– Percutaneous Transluminal Angioplasty and Stent Placement:
Uses an angiographic approach and specialized catheters to dilate a stenosed vessel

Uses a combination of interventional stents and surgical grafts to treat aortic aneurysms and traumatic vascular injuries

Uses an angiographic technique to place a filter in the inferior vena cava to treat pulmonary emboli

Procedure that uses a dissolving agent injected through catheter into the region of the thrombus or clot, whereby the clot is lysed (disintegrated)

Uses a range of agents such as vasoconstrictors, vasodilators, chemotherapeutic drugs, and radioactive materials to treat disease

Procedure that removes foreign bodies such as (calculi, fragments of vascular catheters or guide wires, pacemaker electrodes, and shunts) through the use of loop snares, basket catheters, or endoscopic grasping forceps.

Percutaneous Vertebroplasty and Kyphoplasty
Used to treat patients who have vertebral pain and instability caused by osteoporosis, spinal metastases, compression fractures, or vertebral angiomas.

Procedure involves a percutaneous injection of acrylic cement into the vertebral body under fluoroscopic guidance to stabilize the spine

Involves placing a stent for decompression of the obstructed bowel done preoperatively to reduce postoperative complications in the case of bowel obstructions and as palliative measures for colonic strictures

1. Performed for both diagnostic or therapeutic reasons and is useful in treating several types of kidney pathologies or disorders

2. Used diagnostically for renal function assessment, a urine culture, etc.

3. Therapeutic reasons include stone diversion, chemolysis, and abscess drainage

Used as a palliative procedure for unresectable malignant disease

Indicated when abdominal or pelvic abscesses cannot be readily treated by simple incision and when the location of the abscess is in a safe place for needle entry

Performed when primary or metastatic malignancy is suspected

Performed for:

1. Extended feeding (greater than 4 weeks) of patients unable to eat

2. Gastric decompression

3. Dilation of upper GI tract when the oral approach fails

1. Typically a multiphase format offering 12 pulses per second that offers high performance capabilities

2. Allows for high mA stations and low kVp settings that improve the visibility of contrast medium against surrounding soft tissue structures

3. Allows for shorter exposure times, which reduce radiation exposure to the patient

Volume limiting device-
Pressure limiting device
Acceleration regulator
Rate-rise control

-Should include four-way floating capabilities
-Should be constructed of a low radiation absorbing plastic and carbon fiber material

1. Digital Angiography
2. Digital Subtraction Angiography
3. Digital Cineradiography

-“Spot filming”
-used when only a few images are needed for a procedure

-“subtracts” or removes bone and soft tissue structures so that the resultant image demonstrates only the vessels of interest containing contrast media

-Normally used when imaging vessels in the head, chest, and extremities

Arteriography
Venography
Angiocardiography
Lymphography

To identify the anatomy or pathologic process of blood vessels

Commonly used method for catherization (expound)

Common Carotid Anteriography (expound)

Digital Angiography,
Digital Subtraction Angiography,
Digital Cineradiography

-“Spot filming”
-used when only a few images are needed for a procedure

-“subtracts” or removes bone and soft tissue structures so that the resultant image demonstrates only the vessels of interest containing contrast media

-Normally used when imaging vessels in the head, chest, and extremities

-Involves taking numerous exposures (frames) in a second of time

-Able to demonstrate events that are normally too fast or cannot be seen by general fluoroscopy